CONTENTS
Tuesday 16 June 1998
Subcommittee report
Ministry of Health
Hon Elizabeth Witmer, minister
Mr Ron Sapsford, assistant deputy minister, institutional health and community services
STANDING COMMITTEE ON ESTIMATES
Chair / Président
Mr Gerard Kennedy (York South / -Sud L)
Vice-Chair / Vice-Président
Mr Rick Bartolucci (Sudbury L)
Mr Rick Bartolucci (Sudbury L)
Mr Gilles Bisson (Cochrane South / -Sud ND)
Mr John C. Cleary (Cornwall L)
Mr Ed Doyle (Wentworth East / -Est PC)
Mr Gerard Kennedy (York South / -Sud L)
Mr John L. Parker (York East / -Est PC)
Mr Trevor Pettit (Hamilton Mountain PC)
Mr Wayne Wettlaufer (Kitchener PC)
Mr Terence H. Young (Halton Centre / -Centre PC)
Substitutions / Membres remplaçants
Mr Tim Hudak (Niagara South / -Sud PC)
Also taking part / Autres participants et participantes
Mr Gilles Pouliot (Lake Nipigon / Lac-Nipigon ND)
Clerk / Greffier
Mr Viktor Kaczkowski
Staff / Personnel
Ms Anne Marzalik, research officer, Legislative Research Service
The committee met at 1532 in committee room 2.
The Vice-Chair (Mr Rick Bartolucci): Could we call the meeting to order, please. First of all, I'd like to welcome everyone to the first official meeting on estimates. We will be dealing with the Ministry of Health estimates first, but before we do that, I'd just like to introduce Carolyn from Hansard and welcome her back and, of course, for the first time I'd like to welcome our clerk, Viktor. This will be his first experience at estimates. We know it will be a satisfying and rewarding one, Viktor. Welcome.
Clerk of the Committee (Mr Viktor Kaczkowski): Thank you.
SUBCOMMITTEE REPORT
The Vice-Chair: Before we go into the minister's estimates and before we discuss them, we have a subcommittee report. Is there a mover to that?
Mr Gilles Bisson (Cochrane South): I move that we adopt the recommendations of the subcommittee, and I'll just read it for committee members:
"That the Chair of the committee be directed to write to the government House leader requesting that the standing committee on estimates be authorized to meet for a total of 20 hours over a period of four days during the summer recess."
The Vice-Chair: Any discussion?
Mr Wayne Wettlaufer (Kitchener): Chair, as you're aware, the government has sat for a long time over the course of the last three years. We have passed more legislation than previous governments. As a result, all of the members, not just the government members but the members of the opposition, really haven't had enough time to spend with their constituents. I personally feel that we need more time to spend with our constituents during the summer and, as a result, I would be inclined to ask the House leaders to make this decision as opposed to the committee making the decision.
Mr Bisson: That's exactly what the motion reads. We're asking that the Chair send a letter to the House leaders and basically we're asking the House leaders for an additional 20 hours. In the end, it will be the decision of the House leaders. It's just a recommendation from the subcommittee.
Mr Wettlaufer: Actually, that's not the way it's worded. It's worded that the committee makes the decision to request the House leader to authorize it. Personally, I feel it's a matter of negotiation between the House leaders; it's not a matter for us to decide.
Mr Bisson: Again, it's standard. We do this every year whenever there are estimates, and we have done it with every government. Basically the process is that we make the request and then it's up to the House leaders to negotiate it, but they need to know from us, do we want any time or don't we want any time? What we're saying is that we want four days, a total of 20 hours, and then it's up to the House leaders to decide.
The point I'm trying to make is that it doesn't bind the committee. It's a recommendation from the committee.
Mr Tim Hudak (Niagara South): In support of my colleague Mr Wettlaufer, I think if you look back to 1995, this committee didn't sit through the summer, nor in 1996. There was some time in 1997. I think we would all agree that was a rather extraordinary schedule in 1997.
I support Mr Wettlaufer's thoughts. I think it should be up to the House leaders. If the House leaders feel it's wise for this committee to sit, then let them make that decision, but my feeling is not to support the recommendation of the subcommittee.
Mr Gerard Kennedy (York South): Speaking as a participant in the subcommittee, I know that Mr Young and the other people who participated were looking at the number of hours available to this committee. If we don't decide to sit in the summer, we'll have a below-average number of hours available to us. In other words, we won't be able to fulfil our full role, or we won't have as good a chance of doing that. Because there are always delays, unavailability of ministers and so on, we won't be able to do that. That was the driving thing here.
At the time, Mr Young didn't know whether the House might sit or might be brought back for different things, the date we might return, so this was just giving us an ability, if necessary, to fulfil our duties by having this provision. He negotiated -- I can't recall exactly, but the hours and so on were discussed in the negotiating committee. It's a provision, and I think it's a reasonable one. I certainly would regret it if we hamstrung ourselves and weren't able to get at our role because there were changes in the House or whatever.
Mr Bisson: Two points, and I'll try to explain this clearly. We're "requesting that the standing committee on estimates be authorized" is what it reads. We're requesting. It doesn't mean to say that the House leader is bound to it, plus you have me on record on Hansard saying it's up to the House leaders, so I don't understand the problem.
Second, if a member of your caucus comes to our subcommittee and says, "Okay, we're agreeable to that; let's bring that back to the committee," normally it's standard that the person who represents your caucus in the subcommittee speaks for your caucus.
If I am to believe that whenever I negotiate with your subcommittee member it doesn't mean anything, maybe we shouldn't have any subcommittee meetings, or you guys get your act together, either one. But I don't appreciate going to sit down with your subcommittee member, taking the time to have the meeting in order to come to some sort of accommodation, being told by your subcommittee member that the motion is okay with your caucus, and then you guys come in and override him. What's the point?
The Vice-Chair: Maybe if we put on the record that in fact the intent of the motion is to have the three House leaders arrive at extra hours, and if we can get that on the record without going into amendments etc, we can vote on the report. Is that clearly understood then? Let's call for the vote.
Mr Bisson: Can we have a recorded vote, Chair?
The Vice-Chair: A recorded vote is asked for.
Ayes
Bisson, Cleary, Kennedy.
Nays
Doyle, Hudak, Parker, Pettit, Wettlaufer.
The Vice-Chair: The recommendation is defeated.
I take it there will be another subcommittee report and there will be another resolution coming to the committee at some point in time.
MINISTRY OF HEALTH
The Vice-Chair: Without wasting any more time, the procedure for today will be to allow the minister 30 minutes uninterrupted time. Following her 30 minutes, the official opposition will have 30 minutes to make a comment or ask questions, then the NDP, and finally the government. After the 30 minutes has been exhausted, we will start 20-minute rounds. The 20-minute rounds will begin with the official opposition, the third party, and then the government, in that rotation. Are there any questions?
Welcome, Minister, and welcome to your staff. We look forward to your presentation.
Hon Elizabeth Witmer (Minister of Health): Thank you very much, Mr Chairman and members of the committee. I'm certainly very pleased to appear before you this year as the Minister of Health to review the estimates for 1998-99. With me for the committee proceedings is the Deputy Minister of Health, Sandra Lang. I certainly do appreciate the opportunity to discuss with you the achievements of the Ministry of Health and our government with regard to Ontario's health system over the past three years, and to also outline for you today our direction for the future.
Since becoming health minister in October of last year, I have spent considerable time meeting with many, many Ontarians, particularly those who have a stake in our health system, be they patients, professionals, providers or others. My purpose has always been to hear the views and to get the input of these individuals as to how Ontario's health system can best respond to their needs, because it is those individuals who can provide us with the best assessment of the system and who can detail how our government's reform of the health system is affecting them.
I am pleased to say that as a result of the discussions and consultations I have had, there does continue to be a consensus that we do have in this province an excellent health system and that the basic principles that determine the health system decision-making are indeed excellent as well. It is these principles that will shape the future of health services in Ontario. They include the following: a system that offers the highest quality of care possible; a system that capitalizes on the benefits of medical science and technology; a system that is accessible to all Ontarians in the province of Ontario; a system that is becoming more and more integrated; and a system that remains affordable.
What we need to continue doing as we progress with health reform is to build on the existing strengths of the health system while also being very mindful of both the pace of reform and the impact that the reform does have on the individuals who work within the system and those who receive the services of the system.
While we all know that health system changes have been taking place in Ontario for the past three years, I would like to take a few moments now to explain why our government set out to reform such a major institution, one with which virtually each and every Ontarian will have contact during some stage of their lives.
Our prime consideration continues to be the profound need for us to anticipate and plan for the changing needs and expectations of a growing and aging population. Our health system must be capable of effectively and efficiently responding to the health needs of all Ontarians, and it must be prepared now to be able to provide appropriate, accessible services for the people of this province not only today, but well into the next century.
Through numerous initiatives taken by our government, we are moving forward to create an integrated health system where high-quality patient services are first and foremost. We are actively working to ensure that a continuum of care can be provided to people, to make sure they receive the services to which they are entitled at every stage of their lives and to bring those services as close to their own homes and communities as is possible.
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When we took office in 1995, we inherited a health system that was designed for the needs of Ontario's population in the 1950s, 1960s, and 1970s. It was clear that it was not responding to the needs of the changing, growing and aging population of the 1990s. It also was not responding to the changes that had taken place in medical treatment, technology and new drug therapy. As well, there was no recognition of the fact that hospital stays were dramatically shorter than in the past. Indeed, as we embarked upon reform, we learned that Ontario was the last province in Canada to begin down this road.
Let me give you an example of what our government faced three years ago. In the previous decade, about 10,000 beds had been removed from the hospital system, yet all the overhead and administrative costs remained. Our resources were being spent not on improving the health of people in this province, but on maintaining unused buildings and facilities.
Consequently, in the past three years, Ontario's hospital system has undergone tremendous changes. We have seen, as I said, incredible advances in medical technology, new surgical techniques and new drug therapies. We know that today patients are spending much less time in hospital, and more and more diagnosis and treatment is taking place on an outpatient basis. If we take a look at some of the new techniques in gall bladder operations, and certainly in dialysis, which in some cases is taking place now within the home, we can see that indeed there is less time today being spent in hospital than ever before. In fact, over 70% of all the surgery in the province now happens on an outpatient basis.
The reduction that the system faced in beds, and that was the 10,000, is the equivalent of about 30 medium-sized hospitals, yet we had not seen any reduction in the number of hospitals or hospital buildings. This costly surplus capacity in the hospital system is one of the principal reasons that the Health Services Restructuring Commission, under the leadership of Dr Sinclair, was established as an independent body operating at arm's length from the government. Indeed, the government gave the commission the responsibility of making decisions about health services restructuring and providing advice to us on the health system.
The commission has travelled across the province to examine all elements of the health system. It has consulted with Ontarians and it has determined how the system could better serve people. In particular, the commission is identifying specific areas where we can expect pressure to build and where improvements must be made.
For many communities, restructuring has meant that their individual hospitals and their hospital boards will merge. Services will be consolidated, and unneeded and unused buildings will be closed. It is not an easy process to manage, but hospital chief executive officers and senior administrators have told us it is necessary. In the words of Michael Strofolino, president of Toronto's Sick Children's Hospital, "There were too many dollars in the hospital system tied up in duplication and inefficiency, in bricks and mortar, rather than people."
Restructuring was and is not always a popular process, but as an editorial in the Ottawa Citizen pointed out:
"The outspoken resistance to closing any hospitals anywhere is slowly giving way to a public awareness that attempting to keep every hospital open will extinguish all hope of maintaining and improving an effective health care system. That change in perception is due in large part to the professional, careful manner in which the Health Services Restructuring Commission is handling a task few would covet."
So now we are in this province making the tough decisions and we are creating modern hospitals with the latest technologies. Linkages between hospitals are improving, as are linkages between institutional and community care, and at the same time existing services are being used more effectively than ever before. What this means is that Ontarians now are being served with better services and treatment. As I indicated to you, we are endeavouring to ensure that these services are brought as close to home as possible.
Certainly the consolidation of hospital programs, the reduction in the number of hospitals, and the requirement of higher levels of efficiency in hospitals will save money. However, closing hospitals is not the goal of the exercise. The goal is to free up money for reinvestment into patient care, into ensuring that we have the necessary health programs and services, such as cardiac and cancer services, to treat people in this province. We want to make sure we have the best possible health system.
The anticipated result will be better managed, more coordinated services, and improvements that build upon the current strengths of the system. The challenge of change is not to tear down what we have and start building from scratch. It is to take our excellent health system and make it even better.
Restructuring is also about amalgamating hospital programs within communities and eliminating the overlap and inefficient duplication of services so the system as a whole offers people access to the best-quality programs and treatments available.
As you know, reforming our health system is a considerable challenge, one that does entail the greatest reinvestment in health services this province has ever seen.
This reinvestment is saving lives. Money spent in such areas as breast cancer screening programs is a testimonial to this. We reinvested $24 million into breast cancer screening programs and we anticipate that this will reduce death in women between the ages of 50 and 70 by about 30%.
This reinvestment in priority programs such as improved access to cardiac services also helps us to accommodate more procedures and reduce waiting lists. We have invested $65 million for cardiac surgeries and facilities.
There is evidence that there is improved access as we take a look at the number of completed cardiac cases for adult Ontarians, which were 12% greater in the first 10 months of the 1997-98 fiscal year than in the same time period the year before, and the waiting time in January 1998 was 29% less than a year earlier. That means that more than 14,000 additional cardiac care patients will have access to needed services.
Again, we've talked about bringing services closer to home. We have in 20 communities expanded or installed new life-saving kidney dialysis services since December 1995 to serve an additional 400 people. Another 23 communities are being equipped with magnetic resonance imaging units, which, when all are in place, will nearly triple the number in existence in Ontario compared to when we took office in 1995. Again, they will provide faster diagnosis for some 22,000 people. With additional medical technology available closer to home, Ontarians will be able to obtain many of the vital diagnostic and treatment services they need and will not need to travel as far. They will have less stress as a result.
Our list of specific reinvestments is a lengthy one. In fact, it includes over 70 since 1995.
In addition, we have set aside $2.5 billion to help our hospitals with the costs of restructuring. As you know, we did listen to the hospital community, and the planned third year of budget reductions for hospitals, which was initially scheduled for 1998-99, will not occur.
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All of these decisions were supported by Ontario Hospital Association past president David MacKinnon. He said: "Fortunately the government listened to the advice we presented. We particularly valued these decisions because they were not easy and the problems hospitals were facing were a result of 15 years of inappropriate policy, not just recent events." I think that again emphasizes the fact that we were responding to a system that had been designed for past years, and it was time to embark on reform.
The need for reinvestment also hearkens back to the impact of a growing and changing and aging population. We cannot emphasize enough the fact that we need to take this into consideration.
As you know, next year has been designated the International Year of Older Persons by the United Nations, in recognition of the fact that we do have a radically different makeup of a larger and older population. In fact, during the next decade, the number of people in Ontario over the age of 75 years is going to increase by about one third. The coming millennium will see the greatest number of seniors in history. That is no surprise, given the sheer numbers of the post-Second World War baby boom and the extraordinary advances in medicine that are keeping people healthier longer.
The indications are, from Peter Uhlenberg of the University of North Carolina, that a 60-year-old American woman living at the end of the 19th century had only a 7% chance of having a living parent. If the woman was living in 1940, the chance increased to 13%. However, today, as we stand on the brink of the 21st century, some 44% of 60-year-old women will have at least one surviving parent.
This dramatic shift in demographics may be worldwide, but we in Ontario must be sure we devise contingencies that respond to our own needs. Nowhere is this more evident than in our government's response and responsibility to prepare our health system to meet the needs of Ontarians in the new century.
One of the most significant challenges that we face, therefore, is the increased need for availability of community-based services. At the root, of course, is the fact that there is a decreased need for prolonged institutional care, so we're seeing changing patterns of practice.
As a result, we recently announced the single largest expansion of health services in Ontario's history. We put aside $1.2 billion in additional funding for long-term-care community services and facilities. This investment will directly benefit thousands of people and will enable our health system to meet the demands of our aging population. At the conclusion of this multi-year investment, the long-term-care budget will have increased by 69%.
Over the next eight years, we will create 20,000 new beds in nursing homes and homes for the aged, we will renovate 13,000 beds with new design standards, and we will provide $551 million in annual funding to community-based services such as home care, in-home nursing, Meals on Wheels and supportive housing for the physically disabled. This investment will mean improved access to community-based services for an additional 100,000 Ontarians and will also create 70,000 new jobs. That includes 27,500 new front-line health positions and 42,500 construction jobs.
This announcement is very significant not only because it represents the first new announcement, the first new award, of long-term-care beds in 10 years, but also because it has an impact on the other parts of our health system. It will free beds in hospitals that now can be better used for acute care and emergency patients.
Indeed, David MacKinnon expressed his support for the plan, noting it "will significantly improve health care services for people across the province." He also noted that until now, the chronic shortage of long-term-care services has meant that patients who should have been discharged from hospital could not be because the support was not there in their community. David Cutler, president of the Ontario Nursing Home Association, voiced similar support, applauding our government for showing foresight by working now to prepare for an aging population. Mr Cutler said that by shifting the elderly out of expensive long-term-care hospital beds into a more flexible setting, the province will be able to provide the most appropriate care for the best possible price.
Also, these announcements will enable our senior population to live with the highest quality of life and also allow them to remain independent within their own home as long as possible.
Prior to this major long-term-care announcement, we also responded quickly to the recommendations of the emergency services working group by announcing the creation of 1,700 interim long-term-care beds and the expansion of home care services to assist hospitals in meeting emergency services demands. Of the $225 million we've committed over two years, $75 million will also support patient needs by allowing hospitals to open temporary beds in times of peak demand. That will certainly help us with the emergency room overcrowding situation. We will also be increasing training for critical care and emergency room nurses by spending $1 million.
To date, we've also committed millions in new funding support for Ontarians in community-based long-term care who now receive nursing, housekeeping therapy and a range of other community services. Home care spending in Ontario is 60% higher today than it was just five years ago. Of course today, families have the added advantage of having a single entry point to Ontario's long-term-care system through the establishment of 43 new community care access centres, CCACs.
Our new CCACs coordinate access to long-term-care services. They help people, they help families obtain the homemaking, nursing therapy and the other services they need at home. They also manage admissions to nursing homes and homes for the aged. Last year they helped 32,000 Ontarians, including people of all ages who were returning home after an operation in a hospital. Also, they helped the frail seniors with their daily tasks.
However, our work is far from over. I've spent considerable time speaking with our health partners, and it's obvious that the continued success of our health reform will be based to a very large degree on the development of an even closer consultative partnership between the government and our health partners. It is very important that we work together to manage change so we can do so and improve and integrate health services in an orderly fashion.
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The consultative process is significant, and it is reflected in several of the new initiatives we have established, such as our women's health council. This is an advisory body to the government, and it will provide us with information as to how we can improve health services and standards for women in this province. This year alone, we have set aside $10 million to fund women's health issues. The Ontario breast screening program is being expanded over four years. This means that five times as many women can be screened, and as I indicated before, we have the opportunity of reducing death from cancer by about 30% in the age group of women between the ages of 50 and 70. We're expanding cancer care in Ontario with funding of $16.5 million, including $700,000 for a comprehensive cervical screening program. We are also expanding the eating disorder programs in Ottawa, Toronto, Windsor and York region with funding of $1.5 million, and we are creating some new programs. We have spent more than $1 million to fund research into women's health this last year.
We've also created Cancer Care Ontario, which will benefit all people in this province. It is the provincial body that will coordinate and integrate cancer treatment services. It will make it easier for patients to obtain new drugs, therapies and emerging technologies. It will develop guidelines and standards to further improve the quality of patient care.
When we talk about building a health system to meet the needs of Ontarians in the next century, we know that we need to focus on our children. We all know what happens to our children when we fail to invest in them. We know that when children are at risk they are more likely to suffer health problems, experience conflict and do poorly academically. That's why we have put in place a series of prevention programs, because we know that if we introduce these prevention programs, there is a much better chance of not only preventing health problems but reducing the social and financial costs of dealing with these problems later.
So we are moving forward very aggressively on the Healthy Babies, Healthy Children program. This program, which is an interministerial program, is going to ensure that every baby is assessed at birth and a determination made as to whether that young child is at risk of physical, emotional or learning problems. If so, those children and their families will be supported by public health nurses and lay visitors. It has been designed in a way so we can ensure that we have universal screening, and this will happen each year. The newborns will be identified and they will be assessed. We decided, in the last budget, to increase the funding for the Healthy Babies, Healthy Children program. We believe it's necessary, so our investment is growing from an annual $10-million investment to a $50-million annual program by the year 2000-2001.
As well, we are also funding the preschool speech and language program. By the year 2002, some 75,000 children are expected to benefit from a $20-million speech and language program for preschoolers. It will be provided province-wide. Last year, some 17,000 preschoolers received services.
As well, we have provided a $10-million grant to help the Invest in Kids Foundation support education, research and public awareness initiatives for children and their families.
To help women with parenting skills and prevention programs, so we can protect children from neglect or abuse, there has been a commitment of $4.6 million annually to the Better Beginnings, Better Futures program. More than 4,000 families with young children in eight economically disadvantaged communities have received ongoing support to enhance their children's capacity to develop into healthy adults with self-esteem.
The Chair: Mrs Witmer, you have two minutes left.
Hon Mrs Witmer: Okay. Another program is the heart health program, a $17-million investment again. We're also focusing on launching a tobacco use prevention campaign. We're looking at alcohol and drug abuse prevention programs. We're encouraging people to exercise and become more fit. Of course, we're working on the rural and northern framework to ensure the accessibility of services without this program.
We have invested money in priority programs as well in this province: hip and knee, cardiac care, cancer and dialysis.
We've also announced five primary care projects. Also, we took significant steps this last month with the creation of an integrated and comprehensive mental health system that focuses on prevention, improves public safety and access to services.
These, then, are some of the initiatives we have undertaken at the Ministry of Health. We today spend $18.5 billion; that's up from the $17.4 billion when we were elected. We believe health is a priority for people in this province and we will continue to do everything we can to ensure that people in this province have the services they need, when they need them, and as close to home as we can possibly provide them.
The Chair: Thank you very much, Minister. We'll now go to the official opposition. You have 30 minutes to either make comments or ask questions.
Mr Kennedy: I'd like to make a few opening comments. I thank the minister for her remarks. This is, I think, a consequential time for us to be dealing with the health ministry. There probably has been no other time in the history of Ontario that there have been so many questions raised about the quality of health, the access to health, the ability of people to achieve basic health care in our province. While I am comforted to know that the Minister has a recitation of things that are meant to make us believe that everything is fine, it's very important that we get oriented as we start this discussion.
I'd like to introduce a number of people into this discussion:
There is a woman named Ellen who lives in Hamilton whose sister waited 12 hours to have surgery for an appendix, who is living now with pockets of infection because there was no room in the operating theatre; there was no place for Ellen's sister to get the surgery she required. The 12 hours has made a difference in the quality of life she has.
There is Mary, who has an 87-year-old mother in hospital. She visits and feels worse, she says, each time she goes to hospital, because each time she goes she sees nurses run off their feet who barely have time to change her diaper. They are too rushed to be able to give her any personal attention whatsoever.
There is Brenda, who's been a nurse for 20 years. She lives in Brantford. She works in another field right now, but as the result of recent experiences with her emergency room, she and her family are no longer willing to go to that emergency room with her and her family in future.
There are home care workers in different parts of the province, like Elizabeth in Trenton and others, who are experiencing lower hourly rates and no benefits as a result of the change in policy initiated by this government, with the total insecurity that comes with that from the people we would like to depend on to provide for our mothers and our children and anyone, grandmothers, who need assistance at home.
We also see Margaret in St Catharines, a cancer patient who got treatment in one of our most reputable hospitals. She has been encountering broken-down cancer machines and waiting for treatment and bad backups and lineups in terms of what's happening.
There is a nurse in Toronto who encounters every day a pit in her stomach because she has to participate in the decision-making of what she calls the "big circle with beds," the time of the day when surgery is started, when people start to come in through emergency and people have to be released from her hospital earlier than it's safe to do so. Every day she has to participate in this because that's the state of health care in Ontario.
Madam Minister, I'm certain that it is only fair to say that there have been problems at other times in the cycle of providing health care, but it is becoming increasingly clear -- and we want to thank you for your remarks and taking office to remind us -- that this has been a government without a vision, without a plan for how to conduct health care. That has certainly become very, very apparent, that this has been a very flawed experiment we've embarked on with some very significant cost.
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We want to keep in mind the focus of health care: the people who've been lying in the emergency room hallways, people like Ed Whitehill in Peterborough, who was discovered there, dead, by his daughter. The Whitehill family tried for months afterwards to get an acknowledgement from the health ministry; instead, the staff of that hospital were accused by your predecessor of having made up the problem and having participated in some kind of exercise to inconvenience their patients. The people who sit on waiting lists, the people who find themselves not protected, have to be the fundamental focus of this discussion we have over the next number of hours.
The thing that has to be brought forward that I would like to get specific answers to is the nature of what's revealed in the estimates. There are the tracks, the trail of what actually has been done and has not been done. What I would put to you is that there has been a reckless policy, a policy that began with cuts to hospitals which were announced in November 1995. Those cuts had no basis, no study; at least we've asked for the study that would substantiate that the $1.3-billion cut to hospitals actually had some forethought, some planning that anticipated how much impact that would have on some of the people I just mentioned.
In other words, sitting in Queen's Park a decision was made to extract 18% of the operating budget from hospitals. That decision has really not been deviated from, and there has been no basis on which to say that patients would be protected, that people would remain safe.
I would challenge you today, if you have such studies, to bring them forward. But what I would make you aware of is that the one study that we were able to get hold of was conducted not in November 1995, but rather a year following. In January 1997 the JPPC, between the hospitals and the ministry, modelled what cuts could take place and said they can't be done without hurting patients, but those cuts went ahead anyway. Those cuts were reckless. Those cuts happened in every community of the province without regard for local conditions. The kind of formulaic adjustments that happened simply did not take into account the histories of hospitals or organizations which had made efficiencies, did not take into account actual standards needed to protect patients.
It also was clear, as you told us, that there has been no plan for the development of health care. Thus we see one of the most dangerous elements of things, which is the application of crude academic formulas applied to the whole province without regard for rural areas, for small towns, for looking after the different needs that need to be served by hospitals and other health services. For example, we have an average-length-of-stay formula that, even to this day, continues to be used in rural Ontario, continues not to really differentiate for the special characteristics of small communities. While there is a surrender on the part of the commission to allow local district health councils to decide whether hospitals can stay open, the number of beds those hospitals have, the loss of funding, is still the decision of the commission, and still based on exactly the same formula being used in downtown Toronto as it is in places like Petrolia.
It's extremely important, Minister, that we hear from you in terms of how you can justify some of the late and ineffective responses to the mess that's been created so that we now have, for example, a lag, a huge gap. It comes down to a certain amount of credibility on the part of your government to be able to make us believe that somehow what you call reinvestments -- you say that money you've actually already cut in most cases and taken out of communities will be coming back, when in many cases the delay will be years for those communities to achieve any comparable services to the ones they're losing in their hospitals. That, I submit to you, is a very significant credibility gap. It is a service gap. It is a gap I would call the Harris health gap, because it's the kind of gap that is causing harm to some of the most vulnerable people in the province.
When we look at the fact sheet -- and we heard you repeat today a number for spending on health care. It's important, as we're in estimates, to use that as a point of reference, because it tells us the difference; something about that gap is really illustrated when we look at the real history of this government. When it took office there wasn't $17.4 billion spent on health care, but rather $17.7 billion. In the following years, when you compare, strictly speaking, operating dollars used for patient care, you find that in 1995-96 there was $52 million less spent by this government. Less money was spent by this government in 1995-96, as recorded in estimates, than the previous government. Similarly, in 1996-97 even less money was spent; another $114 million less was spent by this government. You will, I hope, put in front of us the evidence on how directly comparable operating dollars, dollars that help patients, were actually expended by this government during its first two years in office. What we saw was money leaving the system but not money coming back in.
Minister, we don't know what to make of the current year, particularly with a number of things in that budget, which we will hopefully address very directly in terms of getting your ministry to respond, but we do see a continuing cut in terms of the amount of money going to hospitals. We see continuing problems in terms of actually fulfilling promises. You will know that that is the key thing the people of Ontario are starting to make a distinction between: When your government makes a promise, what you like to call a reinvestment, it doesn't actually affect or assist or help people until the money is actually expended. Of course, the lag time between promises and actual expenditure on the part of the government has been on the order of two years to get programs out.
I will cite just one as an example, because I would like you to respond to it: the program dealing with long-term care. In 1996-97, we were told that $170 million new dollars would be expended. At the end of 1996-97, virtually no money was spent on additional long-term care, on additional home care for people. In the very same period, hundreds of millions of dollars were taken out of hospitals, creating a demand and a need for home care services all across the province. We learn today in estimates that there still remains some $80 million of that program unexpended, that still hasn't been allocated around the province. This is now 1998, we're partway through the year, and if the ministry staff who informed us previously were accurate, the dollars that were from a previous government's commitment, were first identified by a Liberal government in 1990, are $170 million that have nothing to do with --
Mr Bisson: You can say it: the NDP.
Mr Kennedy: The NDP didn't spend the money. The NDP identified the money and announced it a few times, Mr Bisson, and this government has not been shy to do so either, but it's an important $170 million, because it shows very clearly that this government has a track record of not being able to put money into the services it talks about.
I would also like you to table figures, if you have them, to show the overall impact of your reinvestments in the last two and three years. In other words, show us the money working in those communities, because we will put our own figures on the table. We will show to you and to the people of Ontario that the money has not been there for people to depend on. The problems that people are experiencing with their waiting lists for surgery, with their difficulty in terms of getting quality home care, with their other problems, is a direct result of that lack of service.
We'd like to make sure to take this opportunity to provide you with some of the concerns of the people of Ontario. One of the things we also want to make sure we deal with through this exchange is that we deal with some of the myths. One is the reinvestment that people are being told to depend on, to hope for some faint amount of money sprinkled on the horizon that will deal with their current needs.
Then there's the myth you mentioned in your speech today around empty beds; in other words, saying that Ontario had some catching up to do. As I believe you're aware, there are fewer beds in Ontario today than in many, if not all, of the provinces in Canada. In fact, that was the case when we started this initiative. Beds have been closed, not left open with large wards unattended, but instead -- and this is something I would specifically like you to respond to -- converted to day surgery, and those nurses being deployed to provide care.
The difference with your initiative is that you've laid off nurses, specifically. You've cut money and forced services to be taken back. What I would like to learn from you in the course of our discussions is how this is supposed to improve patient care, when we're going to a level of nursing care -- because that's really the only way to express beds -- that's lower than any other jurisdiction in the county. How will that provide for us?
You know from the statistics that came out last week that we have the lowest number of registered nurses anywhere in the country. Out of 10 provinces and two territories, we have the lowest ratio of registered nurses, and we don't have good prospects of turning that around even if there was a commitment. We would like to hear specifically, on one of the most fundamental missing pieces of the reforms you've claimed here today, about coherent outlook, why has there not been a human resources policy that would ensure we have the nurses we need, when we need them, in the places we need them? Right now, what we're hearing about, quite ironically, is nursing shortages emerging, large numbers of discouraged nurses that we're unable to recruit for either critical care units or emergency departments, simply because the lack of funding in the last few years has transformed working conditions such that many of them have chosen to work elsewhere or to not work in this province as nurses.
We would like to hear, is there, at this late date, a possibility of a comprehensive human resources plan that would start to tell the nurses and also some of the specialists, some of the other valuable health practitioners in this province, what they can expect? What can they expect in Ontario over the next number of years? In the last 10 years we've lost 30% of our orthopaedic surgeons. We've lost a significant number -- estimates are as high as 40% -- of the family residents who graduated from the University of Toronto last year to the United States. There doesn't seem to be any responsiveness on the part of the government.
An argument you made today that I would agree with was that some of this change had to be contemplated. Certainly there is an aging population, there are dynamics that have to be dealt with, but if we're going to try and deal with that, one would think we would have specifically a plan to make sure we have adequate human resources, because the health care field is first and foremost composed of those specialized caregivers.
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Minister, I wonder if I could use part of my time to start some of the questioning that I have. I would like to specifically draw your attention to the spending in the last year and in the current year proposed, just on a general basis, asking for your reaction on the overall amount of dollars that are spent. Specifically, there are four items that I wondered if you would help to clarify for me. One is the amount of money spent on restructuring in the last year.
As I think people are aware, there was an allocation of $1.2 billion in the budget. There was $154 million actually spent in the past year and, as I understand, that money was substantially spent for the costs of laying off or firing nurses. Could you verify that that is substantially the money that was spent on restructuring this year and that was the purpose of the funds. Also, I wonder if you could tell us, within that number of $154 million, how much of that was used by the various hospitals you reimbursed for consultants and for other related expenses distinct from separation packages for nurses and other health professionals.
Hon Mrs Witmer: Yes, certainly that money was spent on some of the severance packages as we went through the process of restructuring. You're referring specifically to the $154-million amount?
Mr Kennedy: Yes.
Hon Mrs Witmer: I'm going to ask Mr Sapsford to break that down into details then.
The Vice-Chair: Minister, when anyone is referred to, we ask them to come up to the mike and identify themselves for Hansard so that Hansard can make a record of it, please.
Hon Mrs Witmer: We will follow up and get that specific information for you then, Mr Kennedy.
Mr Kennedy: Thank you. Maybe I could, in the spirit of that, broaden the questions that I'd like responses to about the spending last year.
Hon Mrs Witmer: As you know, that was the first year of making that money available to the hospitals. We're presently going through the process again where they are identifying their specific needs, and again money will be made available to them from that same restructuring fund.
Mr Kennedy: I wonder, then, in the spirit of ensuring that Mr Sapsford is able to bring back the information, if we could include the $245 million of this year's money that is for restructuring costs and if we could also learn what's anticipated. I understand that it's for the past year; in other words, it's for the year already past.
Hon Mrs Witmer: That's right. At the present time that's what hospitals are preparing, that type of information. Then the money will flow out to the hospitals once we can determine that indeed the information is accurate.
Mr Kennedy: There are other things I'd like to have verified when that information comes back. One is the working capital that the budget refers to as being due to restructuring, that $47 million in working capital that was made available to hospitals was somehow related to restructuring -- in other words, it was one time and had to do with lack of cash flow in hospitals -- if we could have information pertaining to that, because it seems to be that that restructuring expense is treated a little bit differently and there isn't very much information about it.
Hon Mrs Witmer: On the $47 million?
Mr Kennedy: Yes. I understand that 15% of the cost of restructuring is absorbed by the hospitals, who are forced to lay people off or hire consultants or engage in those one-time expenses. They have to find 15% of that cost. In the previous year, $23 million had to be absorbed, which really is a further cut or adjustment for those hospitals to make in absorbing that. I wonder if we could confirm the nature of that: How does the ministry view it, is that figure accurate, and so on. If those matters can be brought back --
Hon Mrs Witmer: We'd be happy to bring that information back to you regarding that restructuring money.
Mr Kennedy: There's a significant question I'd like to ask around the policy towards hospital funding in the future. You mentioned it in your speech and it had to do with the so-called third year of cuts. What I'm wondering is, very specifically, when the restructuring commission makes its advice to you around the savings that can be realized in the various communities that it goes into, there is, generally speaking, a variance between what has already been cut -- because the initial cuts were pretty much 12% across the board, with small variances from community to community -- and then the commission comes in, does its rationalizing and says, "Here's what we think should come out of this community." In London's case I understand that the variance was positive and the ministry has agreed to provide that.
What I really want to know is, can you be very definitive? What can the communities which have a negative variance, in other words, which have further savings which are cuts identified by the restructuring commission, expect? Can they expect for those to be postponed indefinitely? Can they expect, when they sit down and negotiate their allocation with the ministry, that that will still be a very serious point of reference and that those cuts will eventually be worked into their operating budget?
Hon Mrs Witmer: Mr Sapsford, did you wish to respond to that?
Mr Ron Sapsford: Ron Sapsford, Ministry of Health.
The Vice-Chair: Ron, this is a lousy room in which to hold meetings. We all know that. Please talk into that mike. Thanks very much.
Mr Sapsford: The question of hospital funding and relationship with the commission I believe is the question. The government's allocations over the last two years have resulted in the savings strategy. The commission is using savings calculations based on the methodology that they developed, essentially to look at options around the placement of programs and services in a variety of hospital buildings. The purpose of their exercise was to look at operating cost savings in helping them to make their decisions about amalgamations and consolidations of hospital programs.
The ministry is using its own fiscal position to allocate hospital budgets and, as was mentioned, the $507 million that was originally planned is not taking place in the current fiscal year. The current hospital allocation is based on that premise and there have been no planned cuts to hospital budgets for the current year.
Mr Kennedy: What does that mean? For hospital administrators that are consolidating, say, in Ottawa or Windsor or other places, they want to know, roughly speaking, because they've started to make overlapping arrangements, what's going to happen in the future in terms of their budget and what kind of certainly they will have. I understand, and perhaps you could correct this at the same time, that you haven't yet been definitive. You've told people that they could have their last year's allocation but you haven't published the list of allocations yet this year for hospitals. I wonder if you could verify that.
But my main question is, what can they expect next year? Will there be individual negotiation with the ministry in terms of the needs of a region? Are you saying, when you say that the commission uses its own formulas, that that will be disregarded entirely? In other words, what London was able to do effectively was to say to you: "Look, the commission came and used these models," which at least were more elaborate than anything you're using. "We need another $9 million per year. You should come across with that because we're in the process of doing the things the commission said we should do. We need this additional money."
I want to be very clear. Are you saying that won't apply in the reverse to communities that, say, close down facilities and so on? Will you then not use that as a guideline or will you just independently negotiate? Or a third option: Are you offering to hospitals that there won't be any cuts this year or in the foreseeable future?
Mr Sapsford: I don't necessarily agree with your first premise about the question of London and the amounts of money. The relationship of the operating budgets that the commission is talking about and the ministry's fiscal position are two different positions. We're in the process now of working through the relationship between the two. The funding of hospitals and the allocation methodology in the past have been based on an equity formula approach and it's my belief that we'll return to that in the future, after we're through this transition process.
The other part of the funding that we're working through now is where the commission has made directions where the service of one hospital is split among two or three others. We will be negotiating with individual hospitals around the allocation of that money as a separate exercise. So for the next year or two, on a case-by-case basis, there will be individual negotiations as we implement the directions of the restructuring commission.
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Mr Kennedy: Just so I can be completely clear, when you refer to your own assessment and so on, is it an assessment similar in technique to what the commission used to come up with their -- in other words, do you use the average-length-of-stay formula?
Mr Sapsford: No.
Mr Kennedy: Could you maybe tell us, because I'm sure there are many administrators out there who would also be interested and communities that would like to know, what does your assessment tool look like?
Mr Sapsford: It's a funding tool that's been used for about the last seven or eight years. It's called the equity formula and it's a mechanism of allocating funds on the basis of average case costs. It weights the service of a hospital based on the complexity of the care they provide and provides resources in that fashion, which is to say it costs a hospital more to pay for a tonsillectomy than it does a heart transplant. So if a hospital is doing a lot of heart transplants, it needs proportionately more resources in order to deliver that service. That calculation is based on the entire number of cases provided by Ontario hospitals in the year. There are allowances made for teaching services. There are allowances made for length of stay. In a few years there were allowances made for rural and northern hospitals as well in terms of cost difference between them. That's the allocation method the ministry has used for a number of years, which is not the same as the approach the commission is using. Their approach was not meant to allocate operating budgets, but rather to make decisions about how services would be consolidated.
Mr Kennedy: The key thing that I think the hospitals need to know is, are you expecting further efficiencies from hospitals in the province as they consolidate and do you expect to capture some of that back in terms of the funding that you do?
Mr Sapsford: Yes, we're particularly targeting -- you have to understand that in terms of physical consolidation, where the commission has directed that physical plants close, that has not yet taken place. At the end of capital construction, when programs are relocated and physical plants are actually closed, I would expect that there would be additional overhead savings then there. The hospitals themselves that are involved would argue yes, there are savings available but not yet. They need to get through the transition period until they can generate the savings.
Mr Kennedy: I guess the specific question then is, are there operating efficiencies? By the way, Northwestern Hospital has already closed and there are other facilities closed. I'd like to have that on the record. But operating efficiencies -- because only 5% of the saving identified by the commission is in buildings. The rest of it is laying off nurses because you believe you need fewer beds and so on. Will you be expecting further operating efficiencies from Ontario hospitals in the next few years?
Mr Sapsford: Savings directly related to closures, certainly. At the present time, though, during the current fiscal year, there are no further operating efficiencies expected of them through the allocation for the current year.
Mr Kennedy: Could you table for us any of the -- if there's a document. Is there any information we could know about how your equity formula funding tool works? Is that something that can be made available and the committee could have a look at?
Mr Sapsford: There's quite extensive documentation.
Mr Kennedy: Great. We'd like to have that. Thank you.
The Vice-Chair: Thank you, Mr Sapsford. Third party. Mr Bisson, you'll start?
Mr Bisson: We're going to be splitting our time between myself and my colleague from Nipigon, Mr Pouliot. I've got a series of questions I want to ask you, but I'm going to save that for later. What I'd rather do right now is just respond to your opening comments, I guess just in the way that I wrote them down here.
One of the things that troubled me is your premise and the premise of your government that nothing really happened in the health care system over the past number of years, that it's only since you guys came to power that all of a sudden somebody figured out that health care, like everything else, is something that's dynamic, something that changes with time, and somehow everybody else was asleep at the switch. I really take offence to that because the reality is that's not the case and you know better than that, Minister.
Our government, and prior to that the David Peterson government, and prior to that the Davis government, and prior to that the Robarts government, recognized that health care is an ever-evolving institution, as we call it, that basically changes with time. As our understanding of health care and our understanding of the treatment of disease change, so does the system. For the minister to say here at estimates and, more importantly, to hear some of the comments some of your colleagues in your cabinet and the Premier make that nobody has ever dealt with this before, I think is a bit of stretch. As a matter of fact, it's a long stretch.
I was part of a government that made a number of changes in the health care system, some of which were not well received because, as you will recognize, some of the changes that needed to be done in long-term care would challenge the existing stakeholders within the community. For example, our government had decided that we wanted to restructure long-term care and move to multiservice agencies that would be controlled under the public sector. Your party was opposed to that. You fought us nail and tooth along the way, along with the Liberal Party, when we were in government. We thought it was the right decision. I still believe it's the right one.
I was surprised after the election that you took half of the idea and said: "That's not a bad idea. If we restructure and put it under one point of access, it does make some sense." You made the decision to go in the private sector. That's one that I don't support. But for the minister to say nothing's ever happened before, nobody has ever tried to take this on, nobody has tried to modernize the system -- I think goes a long way.
Also, the whole issue of central placement coordination when it comes to long-term-care institutions: You well know it was the Bob Rae government -- I think under Ruth Grier; it might have been under Frances Lankin; I may have my ministers mixed up -- that finally wrestled with the issue that long-term-care institutions were not retirement homes, that in fact they were institutions that were there in order to assure ourselves that we were adequately putting the resources where they were best needed. We moved to central placement coordination so that when somebody goes into a long-term-care institution, it would be based on need and not strictly on, "Who do I know on a municipal council that can get me a bed at the local manor?" because that's how it often worked.
I just put those two on the record. The list goes on. The Trillium program: When it came to the drug benefit system, we had hundreds of thousands of Ontarians who were without any drug programs whatsoever. It was the Bob Rae government, again, that put in place the Trillium program -- without user fees. Your government, thank God, at least has left that program in place but you've instituted user fees, something you said in opposition that you would never do, that you've now done in spades in our health care system, as well as others.
The other thing was that you said the system was designed for the needs of the 1950s, 1960s and 1970s and that it hadn't changed. I submit that is not the case. We designed the system certainly for the time, and as time changed and as our understanding of the treatment of disease changed we certainly, all governments, have moved in order to keep the system up to date. I would submit that you hide behind the language of change in order to advance your ideological agenda, which is to privatize our health care system over the longer term. I really get offended when I hear you hiding behind the language of change, because it is, I think, insulting to a lot of other ministers and other people within the ministry who have been working for years at trying to make sure that our system of health care evolves with time. To not recognize that, I think, is a bit of a disservice to them.
The other thing is that it doesn't recognize the work that people in communities like Timmins and Sault Ste Marie and a whole bunch of other communities across the province have dealt with themselves, the issue of, how do we better care for people within our communities when it comes to the hospital system itself? You would know, I would hope, as a Minister of Health that it didn't take the Mike Harris government, or even the Bob Rae government for that matter, for that community to come to terms with, "How can we best serve our community through one district hospital board?" We went from multiple hospitals in our community, without a hospital restructuring commission, at the request of the local people within our community from all political parties who were involved on the various hospital boards, to come together and to merge our hospitals into one entity and eventually to move it into one facility, to where we now have the Timmins and District Hospital located at its new site, something that was funded by our government but certainly something that started before we got there.
Communities, long before Mike Harris ever came around, recognized that health care changes, and as the needs of health care and our understanding of how to treat disease change, the system evolves. It wasn't Mike Harris who all of a sudden figured this out. People figured it out a long time before he ever came around, and I think it's a disservice to the people of the city of Timmins, Sault Ste Marie and a whole bunch of other communities who went through these changes themselves without the prodding of the government because they recognized what they needed to do as stakeholders within the health care system, both from a cost perspective but also from the perspective of providing adequate and sufficient care within their communities.
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Two or three times in your presentation you went on about how people are applauding your government's changes in health care. I don't know. I don't see a lot of applause when I travel around Ontario. I see the hospital association and I see other key stakeholders -- they are stakeholders in the health care field -- applaud some of your initiatives. To say that your government has done everything wrong in health care would be wrong, and I would not say that. But I do not see any kind of unanimous support in the communities across Ontario and people standing up and applauding.
The one thing I am struck with everywhere I go -- it doesn't matter if it's Timmins, it's downtown Toronto, it's Ottawa, it's Cornwall, wherever it might be -- is that the number one concern of people is where our health care system is at. They're genuinely concerned: "Am I going to get care if I get sick?" They look at the changes the government is undertaking, supposedly for the betterment of our system, and they say, "I used to be able to get into the hospital for this kind of procedure before and I'm having a harder time getting in now."
People are generally concerned, and I think they're concerned partly for good reason, because they see that there are a lot of changes that have happened in health care since your government has come to power that have not influenced in a positive way the ability for people to access services.
I would submit that to try to save dollars at the expense of our health care system is a disservice to the people we're here to represent, the citizens of Ontario, because our province, as do the others across the country, understands that health care is a basic right of citizenship. For the state not to provide sufficient, adequate and well-funded health care for people when in need is a problem.
I look at people I've got on waiting lists up in our communities, and I'm sure it's the same in Mr Wettlaufer's area, as it is in yours. We have people on waiting lists trying to get in for cardiac care at a rate that I've not seen in a heck of a long time. That's not to say there have never been waiting lists, but the trends certainly are indicating that the waiting lists for things like cardiac care and other things are a lot longer and people are having to wait a lot longer to get in.
It is not strange for an MPP in this time, or in the past, to have to call the hospital or have to call somebody to try to get somebody into -- for example, in northern Ontario, if you need cardiac services, you need to go to Sudbury. Certainly in the past, other MPPs have got calls in their constituency offices in order to try to get people in, but I am surprised at the amount of people who have been calling us over the last two or three years as compared to before. It's really on an increase.
I think there are a couple of reasons for that. One is that people are living longer, and as they live longer obviously they demand services because of their longevity. But also, quite frankly, our system is not responding to the need out there. I think that's a political decision your government has made. They've said: "We want to save dollars versus trying to provide care." The hiding behind the language bothers me.
I've only got a couple of minutes. I will only touch on one other issue, and that is the issue of reinvestment. I really want to go into detail on the numbers, because with great fanfare you are always out there saying, "We're spending more money on health care now than we did last year."
First of all, the basic tenet is that there is an increased demand on health care year over year so it's automatic that there's going to be more money spent on health care on the basis of demand. But if you look at your numbers, a lot of the numbers you have are restructuring dollars. I would submit that when you look at those numbers and you balance it all out, we actually have less money to respond to what is a greater need. When I look at the numbers, a lot of the extra dollars you're talking about are one-time restructuring dollars that you put in in order to deal with the closure of a bunch of hospitals across the province.
The last point is, when I look in our community, the city of Timmins and across the Cochrane district, for the amount of money you've taken out there has not been an equal reinvestment going back in. The net effect is, people are looking at the system and saying: "It is not responding to me. As I try to approach the hospital I'm having to wait in the emergency ward a lot longer." In some cases you've got no other choice. Because you have no doctors, you have to go to the emergency, which basically means to say people are without a lot of services.
I look forward to the next day of our hearings when I'm able to come back with some of the specific numbers and we're able to get some answers on some of those.
The Vice-Chair: Mr Pouliot.
Mr Gilles Pouliot (Lake Nipigon): Thank you, Mr Chairman, madame la sous-ministre and madame la ministre. I wish I could, Elizabeth, say that it was a renewed pleasure appearing in front of the committee responsible for estimates. The only reason I'm here, or the main reason, is because I represent the largest geographical riding in the province of Ontario. You will comprehend and readily acquiesce by looking at the map that we're fully 26% of the overall land mass. We don't have accessibility to services anywhere near what other people have been accustomed to and, rightly so, taken for granted over the many years.
I mention this to illustrate that therefore, by way of being more vulnerable, we become also more sensitive to decisions that are made, for we are directly impacted. In many instances, while we contemplate the range of services being offered, we have no alternative. In fact, quite often we don't have those front-line services, understandably so; we are spread out over a vast and magnificent area, but there are so few of us that it's not quite compelling for anyone to provide the services. It wouldn't be wise.
Rumours or decisions that are made in haste -- and I'm not imputing motive; I say this with the highest of respect for you and for your office -- take on extraordinary proportions. Of course, we do read. The world is getting smaller that way. We understand your dilemma. You come at a time when you've been abandoned by a senior form of government, and you keep repeating this in the House so we won't forget. It's a normal reaction among us. The fact is, you have accepted the tenure. You must carry the tenure forward.
You have been the government for three years. We have little time to impute motives or to blame others, and I am sure that you will share with me in that sentiment.
What we see, or what we get -- and we understand the challenge, the aging population. The demographics are changing; there are more people. The fact is, you are saying that you are spending more money on health care. Not cynics but critics will say, by way of a challenge, that you are spending less money per capita on health care. When you factor in the aging factor and the demographic -- people who are paying us the compliment of their visit on a permanent basis, and I focus more here on the immigrants who need more help, and they're certainly getting it in large part -- it puts added pressure on the system.
Under pressure, you have surpassed adequacy. You're excellent at announcing programs. And yet when we look at the very estimates, at the actual money being spent, it tells us a different story.
Let me give you an example. Of course, it's true that major increases have taken place. In terms of the human dimension of Harry and Jane, it means little.
Some $230 million in hospitals for medical equipment renewal: This is money to fix the year 2000 bug or problem. When you say you've increased money for health care spending, once it hits the street, it means little that when the clock turns on December 31, 1999, everything will be in order. It's not money that I will see as a patient but a continuation, an acquiescence of normalcy, that the system will still be there.
You're to be commended for $113 million compensation of hepatitis C infection through the blood supply. You're still waiting for the spouse to respond in the affirmative but, you know -- you're not becoming less compatible, you've committed $113 million, but to date you have spent nothing, Madame. The money will be there. The problem I think we may experience is that the people waiting for the money might not be, so hopefully we can reconcile that in relatively short order.
You've given $268 million to the medical profession. I understand that they belong to the best union, and I commend you. You've wrestled them to the ceiling, Minister.
You've added some $169 million to the drug formulary, but I read in the paper recently of a little -- not a battle royal, but a difference of opinion between the lobbyists, that you are freezing the incoming new drugs, if you wish.
Interjection.
Mr Pouliot: You are not? Okay. I will need some information on this as we go on.
Public health: Oh, yes, you've involved another partner -- whether they like it or not, they became your best friends -- that of the municipal entity. There is $224 million public health downloading. You have turned your back. You have given them the back of the hand. They pay for it if they want it now.
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Ambulance service, $26 million: It's no longer your responsibility. You've decided to wash your hands of it.
Laboratory testing: The allocation was approximately $2.23 billion. What are you spending? You are not spending the money. You say you are, but when it comes to the estimate, you have only spent $2.059 billion.
Community mental health: You have talked a good line. You were superb. I was there. There is $212 million allocated. There's no shortage of challenged people, we know that, and yet you only spent $198 million. Is it because in making the transition, the other programs are not in place, but in your government's haste to indulge in conjuring of illusion and a bit of snake oil and telling people what they want to hear, in the policy of appeasement you're saying, "Yes, we're spending more," but then the estimates tell us that you're not spending the money, you're only allocating the money, so in fact you're spending far less?
We know of the nursing shortage because we all have friends, relatives, community members who go to the hospital and who are on the waiting list. We all know of someone who is there yesterday, today and tomorrow.
In 1992, for every 123 Ontarians, there was one registered nurse. In 1997, there is one registered nurse for every 145 Ontarians. There is no getting away from it. Those are front-liners. Those are the people doing the work. Out of those, between 123 and 145, it's somewhat deceiving. It takes on extraordinary proportions in this context because of the need of the 145 vis-à-vis the 123: aging population again.
Health promotion: You budget $13 million; you spend $11 million.
Community health services, underserviced area program, northern travel grant -- don't we know what we're talking about? -- northern diabetes network: $250 million. It's better than it has been, I grant you. These programs are very welcomed by the population, but when you tell the world, "We're spending more," you're allocating more again. You have spent only $231 million; that's $19 million less than budgeted.
Long-term care, community support services, Meals on Wheels, seniors' day programs: I don't wish to be repetitious, but your style is becoming habitual. You budget $127 million, but then you show a reluctance and you spend only $105 million.
Hospital restructuring: This is a combination of severance and capital. You budget $218 million. There again, to say goodbye, you spend only $154 million. That's $64 million less than budgeted.
When all is said and done, when I look at the press clippings and the press releases and I look at the spin, I see everything that you will do, including making us very healthy and very rich in eight or nine years. I have a broker who will make me rich if I can only wait eight years. Eight years from now we will be in our second term of office, and we will still be fixing those messes.
The people want the money now. You spend these things and you add them up when you make the announcement, but when the estimates come along, you're spending less money. Not only are you spending less money than you tell the world you are, but you're spending less than that per capita.
Nowhere is the human dimension more present, nowhere are the expectations and the faith more evident, than with health. You consume one third and more of the public purse in the province of Ontario. We know that there is an evolution. We know that we are all committed, and you, as the chief spokesperson, more so or just as much, to doing more with less. We're not adamant, but when you hear the real stories, notwithstanding that some people, most unfortunately, will fall through the system and will be identified as causes célèbres by members of the opposition -- we have a system which invites confrontation. That's the way we are structured; so be it. It's only doing our job, and we don't always present workable or reasonable alternatives.
But notwithstanding, when you go and visit someone and you find them in the corridor, Madame; when you are asked to wait and wait again to be remanded for another appointment; when you are asked by some constituents if you could possibly buy insurance so you could ease the lineup; when you are restricting accessibility; when you have decreased the home care participation by the province; when mental health has been put on the back burner in terms of essential services; when user fees are being introduced for our seniors; when hospitals are closing in front of your very eyes in the face of more demands; when people are being folded in half in a taxicab and asked to go home, only to return to emergency; when people tour Toronto on a Friday or Saturday evening and have to listen to the communication 12 or 13 times saying there is no room at the inn, Madame; when they watch you fight over an oxygen program -- how are we to respond?
You have 11 million people in the province of Ontario. You have an aging population. You are the recipient of more immigrants than ever. You have the largest budget. But above all, you have a sacred trust, the trust that the people have put in the government, a system that makes us different.
We have one of the highest-taxed jurisdictions in the G-7, in the western world, and we know why. We pay at the source and we pay for a service which is essential to us, and we wish to keep it. It's up to you to be innovative, but do not look at the bottom line. The bottom line is our welfare; it is the essence of life.
In closing, I want to commend you. I know we're dealing with good people, not only in yourself but in the people in your ministry responsible for the different departments. I do encourage you to lobby the Chair of Management Board when it comes to salary review, among other things. We don't often pat them on the back, all of them. We're too quick on the response.
I occupied four ministries with the previous government of the day, and I wasn't always kind and generous to the people who made that job a lot easier, and I'm sure you will be different.
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The Vice-Chair: Three more minutes, Gilles.
Mr Bisson: Mr Pouliot touched on something that I think is important to say, because I think it strikes at the philosophy of where your government is coming from. We in Ontario, as did the rest of Canada, made a decision that we would pay for services like health care and other essential services through our tax base rather than having it as a user fee. In the United States, as in other countries, they have decided that you pay when you need it or you pay via a private insurance system in order to get health care. Here in Ontario, as in the rest of Canada, we said we want to pay that through our income tax system and through various tax systems that we have. Yes, we pay more taxes than other people and there's a reason for that, so that if you get sick, no matter who you are, you can be taken care.
That really strikes at what's going on here, because your government made a choice in coming into office that it was more important to give people a tax cut than it was to provide for adequate health care and other social services to our population. You nod your head, but that's exactly what you're doing.
I think that's what separates your approach from our approach. We believe that a progressive tax system is not a bad thing; it's a good thing if it's being utilized for the betterment of the people we represent. As the New Democratic Party, we believe that health care and other essential social services are extremely important for the health of our citizens and our communities, and it's far cheaper to pay for that via the tax system than it is to pay it in the end through your wallet or through an insurance premium once that ends up in the private sector.
One of the things we're saying probably going into the next election is that the tax cut issue has to be relooked at. I quite frankly am uncomfortable in a society where we decide that it's better to give people a tax cut at the top end of the income scales than it is to give people a hospital bed, bypass surgery, cancer treatment or whatever it might be, because it makes somebody feel comfortable at the top end of the tax scale. I think it's a question of choices. You've made yours; I certainly would not have made the same decisions.
The Vice-Chair: Minister, you have 30 minutes now. It's your time. You can continue on with your presentation, you can turn it over to some staff, you can offer some rebuttal points to the two parties in opposition or you can entertain questions from the government side. It's entirely up to you.
Hon Mrs Witmer: I appreciate that. I think what I will do is continue with my presentation. I appreciate the remarks of the members of both parties.
I want to preface my remarks by saying in response to you, Mr Bisson, that there is no intention to privatize the health system. That's certainly not our objective. Our objective truly is to ensure that all money that is used in health care goes to support people and health services and health programs in Ontario. Again, I indicate to you that we want to make sure that whenever possible people in this province have the services close to their own communities, and if at all possible, within their own homes.
I think both you and Mr Pouliot can well appreciate some of the distances that your constituents are forced to travel. Obviously, by expanding the dialysis services, by making the MRIs available, by putting the $551 million into the community services, we certainly are trying to ensure that people in parts of the province where they don't have the same access as they may in Toronto do have those services provided as close to home as possible.
If you take the long-term-care dollars for the facilities, again some communities that might not have had beds will now, as a result of our investment, be able to stay in facilities within their own towns, as opposed to moving to the city and being forced to leave their friends and family, and certainly will have a better quality of life for being able to stay there.
Mr Kennedy referred to the fact that there are people throughout this province who obviously have experienced health issues that are of concern to all of us. It's because of the problems people face that we are making the changes. Unfortunately, there will always be people who experience problems, but we want to make sure that with the reforms we are making we will see fewer and fewer problems and we will see people receiving the level of care and the appropriate service in accordance with their needs. That's why we're making the changes we're making. Certainly I share Mr Kennedy's concerns when he indicates there are those people.
However, having said that, last night I was at a Liberal function -- Mr Kennedy and I were both there -- and it was interesting that several people in that audience made their way over to tell me that they appreciated the changes that were being made to the health system. In fact one individual said he'd be pleased to talk to Mr Kennedy, because I reminded him that Mr Kennedy often brings the other stories. I think you're going to get a letter, Mr Kennedy. He said he'd had cardiac surgery now and he'd had it five years ago and actually he was very pleased with the service and the nurses. He felt there was a very optimistic atmosphere within the environment where he had been.
I want to focus on the issue of prevention. I talked about the Healthy Babies, Healthy Children program. I talked about speech and language. But what we are endeavouring to do as a government is to ensure that we really shift the focus to wellness and health promotion, injury prevention, injury reduction, because we need to ensure that people are in a position where they can make their own choices about their own health. We want to improve the health outcomes for people in this province. That's why we're introducing some of these programs.
I want to talk about the heart health program. What we're trying to do here is raise public awareness. We know there are three lifestyle factors that are linked to heart disease and cancer. We know that if we can make the public aware of the fact that they need to do something about those lifestyle factors, we could reduce the amount of money that is presently being spent to treat heart disease and cancer. We are encouraging people to adopt a more healthy lifestyle, and that really involves three simple things: physical activity, healthy eating and not smoking.
The Vice-Chair: Excuse me, Minister. If anyone's following from the prepared notes, the minister is on page 10.
Hon Mrs Witmer: We've made a $17-million investment over the next five years into the heart health program, because we know that at the present time more than three out of four Ontario adults have at least one of these risk factors for heart disease. That is costing us every year in this province about $2 billion, and of course we lose another $4.5 billion annually in productivity in the province.
This heart health program encourages people to make positive changes in order that they can protect their health, quit smoking, eat a low-fat diet and hopefully keep active. We anticipate that through this campaign we can reach about one and a half million Ontarians and hopefully reduce our health costs and improve the health outcomes of people in this province.
Some of the other initiatives to prevent disease and injury and to promote good health are:
We're taking a very comprehensive approach to curbing tobacco use and it's one that has served as a model for other provinces as well. A commitment has been made over three years to launch tobacco use prevention campaigns across the province and we have a toll-free Quit Smoking support line that's being tested as well.
We're also working very hard to prevent alcohol and drug abuse. In addition to the many addiction prevention programs funded by our government, the focus communities program, which is a partnership with business, community agencies and volunteers, has been established. Over half a million people were reached last year alone thanks to this $1.3-million project which is designed to prevent alcohol and other drug abuse in high-risk communities across this province.
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Two thousand teachers and health professionals will be trained to implement ACTION, a three-year innovative program introduced in 1997-98. This is a program that is directed at students who are at a very vulnerable position, in grades 7, 8 and 9. There's a tremendous amount of peer pressure, as you know, in those age groups and this ACTION program is designed to assist them in making a choice and to help them from becoming involved in substance abuse.
As well, we're encouraging Ontarians to exercise more. Two thirds -- that's just an unbelievable number of people in our province -- are considered to be physically inactive. Again, we must do everything we can to get those people moving and active. So we have a Summeractive campaign to increase awareness and understanding of the benefits of physical activity. We have 3,000 community event leaders bringing the message of the benefits of physical activity to people of all ages. As well, Active Schools is a new program designed to increase the number of active youngsters in Ontario by improving curriculum learning strategies to give an anticipated two million students the knowledge and the motivation to be active throughout their lives and to increase opportunities for students to be active during the school day. Maybe you'll understand that I used to teach phys ed and I think it is extremely important that we encourage these young people to stay active throughout their whole life, because it certainly will reduce health care costs and it will improve their own health.
We're also promoting good nutrition as a key factor in the prevention of heart disease. Certainly there are cancers and there is obesity and type II diabetes, and that is another reason for us to focus on good nutrition. With only 13% of our population presently eating a low-fat diet, we have created the Healthy Eating Manual. It's an adult-education resource developed in partnership with the Ontario division of the Canadian Cancer Society, the Heart and Stroke Foundation of Ontario and local boards of health.
Beyond that, perhaps one of the most important and challenging aspects of our government's health system reform is the improvement of access to health services for Ontarians. As I indicated -- and I'm mindful of Mr Pouliot and Mr Bisson -- we know that there are many people in this province who don't have the same access to services and we are trying to do what we can in order to ensure equal access and also equal funding to people throughout the province.
If we take a look at the size of Ontario, which Mr Pouliot has referred to, we see that we cover an area of over one million square kilometres. We have some 85% of that being forest, unnamed lakes and tundra. Of course, knowing that people live in the north and live in rural areas where there is more limited access to health services, we have responded to the needs of these people with our Rural and Northern Health Services Framework. This framework is going to ensure that rural and remote communities have 24-hour access to high-quality services and links, including telemedicine and specialized care.
If we set aside the framework, we have also recognized that there are other special initiatives that we must introduce to help rural, northern and small communities, because they have problems recruiting and retaining physicians. We have introduced methods such as paying them a $70-per-hour fee for working nights and weekends at hospitals and hospital emergency departments. This program is helping to keep about 70 emergency wards open that were in danger of closing.
As well, the Community Development Officer Project has been expanded to northeastern Ontario. Project officers help to match communities with doctors who hope to establish new practices in the north. Again, we are doing what we can to ensure that physicians in this province look at opportunities outside of the metropolitan centres in order that they can serve the needs of individuals where they are most needed.
The other area where we've seen tremendous advancements take place and we see lives being saved is with the individuals who operate our ambulances. As you know, the ambulances are and have been equipped with defibrillators and symptom relief so that patients receive treatment faster. We have made a $9.7-million reinvestment here. Recently I had the good fortune to attend a function where we had some survivors who are alive today because of the training and the equipment in the ambulances. It's very rewarding to see the ambulances having access to that service in order that people can be sure they make it to the hospital.
We've also expanded priority programs. Mr Kennedy made reference to some of those in the Ontario hospitals. All of the money has been reinvested back into the hospitals. Some $42 million went to heart health last year; $18 million went to mental health services; $8 million was paid for cancer treatment; $18.5 million was spent on dialysis services and kidney transplants; $3 million for bone marrow transplants; $4 million was paid for other transplants -- there are heart transplants nowadays, lung, liver, kidney/pancreas; $5 million was paid for 1,900 hip and knee replacements -- we're seeing the need for more of those as our population ages -- and $3 million was reinvested in the 10 lead hospitals that specialize in treating life-threatening injuries.
As a result, I am pleased to reiterate -- I know there was some reference made to the fact that cardiac patients aren't getting access to the service -- that there were 14,000 additional cardiac care patients who will have access to the needed services; another 13,700 cancer patients will receive care; 400 more people will have access to dialysis services; 22,000 have gained greater access to MRI services closer to home.
We have invested in services to care for the critically injured and in hip and knee replacement to serve about 2,000 people. When you see individuals who before the operation were not mobile, and after the hip and knee replacement are back to where they were, it is a good feeling to appreciate that modern technology and new treatments in surgery are allowing them to have an enhanced quality of life.
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More recently we took a look at primary care, the first step in health care. We made an announcement of five primary care projects in order that we could improve the accessibility to care, make sure it was going to be provided to people 24 hours a day or around the clock and that it would be high-quality patient care. This new model of care in five of our communities reflects the fact that, as we move forward and make these changes to health services, we don't do it alone. We are working in partnership with our health partners. In this instance, there was a partnership with the Ontario Medical Association as we explored more accessible and innovative approaches to delivering health services in Ontario. What we are doing is, we are going to determine what works best for both the patients and the physicians.
Features of this new family medicine model of service include expanded access to on-call services and enhanced prevention services for patients. Physicians will be compensated for the prevention services that are provided. There will be evening and weekend office hours. There will be around-the-clock telephone advice from a registered nurse. There will be improved use of technology. All of these patients will have their records computerized. Patients don't have to enrol in these new projects; it's voluntary enrolment. They can choose their physician or they can choose the physician network.
Earlier this month, we took very significant steps towards the creation of an integrated and comprehensive mental health system that emphasizes prevention, improves public safety and access to services. This was in response to the recommendations that were made by my parliamentary assistant, Dan Newman, as part of his extensive review of Ontario's mental health programs and services earlier this year. At that time, I announced such initiatives as transitional funding for increased community mental health services and inpatient capacity.
As you know, we've already put a moratorium on the closure of psychiatric beds until such time as we have the appropriate community services in place. Our announcement also means that there are going to be assertive community treatment teams, so people in communities are going to have access to 24-hour support services. That was an investment of $60 million to expand mental health services.
We're also going to review the mental health legislation. Dr Stephen Connell, the vice-chairman of the OMA section on psychiatry, said that he was particularly pleased we're going to do this.
As well, the province is going to assume some $54 million in costs for dedicated supportive housing and domiciliary hostels across the province to serve people with special needs. That was an announcement last week. Who are these people with special needs? These are people who have developmental disabilities, mental illness, addiction, and frail elderly Ontarians. That is a change that is now under way.
As well, there were some budget initiatives recently. Again, we recognize the need for some interim long-term-care beds; 1,700 are going to be created.
Nursing: We, as a government, very much value the role of nurses in this province. I have had more than 11 meetings with nurses in order that we can identify the issues they face, because as front-line workers they have dealt with the issue of restructuring and they are in a position to know the impact of restructuring, not only on themselves but on the patients. We want to make sure that, as we move forward, we respond to their concerns.
We've set up the Nursing Services Task Force to take a look at the working conditions and ensure that the nurses are going to be available to do the job they do best in providing compassionate care to patients. As the result of conversations with them, we are embarking on a process of drafting legislation called the Patient Safety Act. This will ensure that we focus on standards within the health system, within institutions, and also that we focus on accountability within the system. Nurses will help us in that.
We've also invested $5 million to increase the accessibility to health services. That money's going to be used to support the nurse practitioners. Mr Bisson mentioned that the NDP had moved forward with new initiatives in health. I want to acknowledge right here that that legislation was begun by Ruth Grier. Recently I had services to people in this province, not only today but also as we move into the year 2000.
That concludes my remarks. How much time do I have left?
The Vice-Chair: You have four minutes.
Interjections.
Hon Mrs Witmer: Okay. One of the areas that was referred to -- and this, I think, was by Mr Kennedy -- was issues that were being experienced in some of the emergency departments in the province of Ontario.
As you know, this year we decided that once and for all we would address the issue of emergency room overcrowding. As was pointed out to us by people who were neutral observers of the health care system, this is a problem that has been ongoing for 10, 15, 20 years. If you take a look at the clippings, you'll see Elinor Caplan prior to 1990 commenting on the situation, and certainly the NDP ministers as well.
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We set up a task force this year, when the issue again became one that needed to be dealt with, with the Ontario Hospital Association. They reviewed the situation, particularly in the greater Toronto area. They made recommendations one morning and in the afternoon we at the Ministry of Health were able to respond to each and every one of the recommendations.
As you know, we committed $225 million. Part of that $225 million was going to allow for us to temporarily create 1,700 long-term-care beds because the task force became aware of the fact that many of the beds that could be used by people coming into emergency were being occupied by people in long-term-care beds. We also recognized that some of the people in hospitals didn't need to be there and could be in their own homes, so again we identified money that would support community services.
It also became apparent that there was a need to train more emergency room and critical care nurses, so some of the money was set aside for that purpose. Also, it was obvious that sometimes the hospitals needed to be allowed to open additional beds. In the past, hospitals had not been funded if they opened these beds. We indicated in our response to the emergency overcrowding situation that if there was a need to open new beds, we would fund the hospitals for those beds.
In very short order, within a very few weeks, we did address and respond very quickly. We certainly believe that as a result of working cooperatively with the Ontario Hospital Association, we are now in a better position to ensure that when we again experience these problems, there are recommendations and changes that are taking place right now that will not create some of these same situations.
Recently I was in Windsor and announced -- they're going through some transitional problems there -- that we were making $2 million more available to Windsor in order to deal -- and that was part of the money out of the $225 million. I handed them the cheque on Monday and they've probably cashed it. So you can see that on the promises that are being made, the money is being made available and people can move forward to respond to some of the health needs of people throughout the province.
The Vice-Chair: We'll start our 20-minute rounds with the official opposition. We'll only get that one round in today, and tomorrow we'll start our rotation with the third party and then move to the government.
Mr Kennedy: Minister, I had a different question in mind, but I would like to touch on emergency, since you raised the subject. You specifically mentioned the Windsor situation. I know you weren't minister at the time, but presume you've become aware that a report was written last year by investigators sent in by the ministry because of how terrible the situation in Windsor had become.
I have a number of cases here; in fact, a very large number from my colleague in Windsor, concerning real-life impacts that emergency rooms presented because they didn't get the reinvestment in a timely fashion. That was supposed to happen last August. The $2 million you're talking about was supposed to be available for transition money to deal with the problems in Windsor last August. There was supposed to be a one-time expansion that would then have to be discarded later on because it was just to deal with the problem.
What I want to know is, why has it taken this long, specifically in Windsor, to deal with the problem? This is not a problem raised by the opposition. This is a problem where two investigators came from outside and wrote a report and specifically said that conditions there were unacceptable, and they rhymed off a lot of reasons why that was the case. I just wonder why, if you're prepared to stand behind some kind of standard in emergency, that did not get dealt with.
Hon Mrs Witmer: First of all, it did get dealt with. Earlier this year I actually did make an allocation to Windsor in order that they could start the construction of their emergency rooms. In fact, yesterday when I was in Windsor I was at the Hotel-Dieu Grace and I had an opportunity to tour the new emergency ward that is being constructed and rebuilt. We had already made that money available. I'm going to ask Mr Sapsford to deal with the particular situation and how that occurred. This $2 million that I took yesterday was to further provide the transitional funding.
Mr Kennedy: Maybe he can elucidate. That there was a delay is my point, because I would like to be answered in this context. The emergency problems: In the report we received for Toronto, they said specifically at their presentation, and their data support this, these problems started to be experienced in the Toronto area in October 1996. They were specific about that. They also said that there were factors relating to the shortage of beds, lack of funds in the system, not just simply to a particular kind of bed being missing.
What I would like to have elucidated is, is the ministry prepared to admit it has made mistakes in terms of providing emergency service?
Hon Mrs Witmer: I think, Mr Kennedy, if you take a look at the report, it clearly states there was not one reason for emergency overcrowding. They indicated there were many reasons, but there was not one single reason for the emergency room overcrowding. I think we have to recognize that fact, that there wasn't one single reason.
Mr Kennedy: In Mr Sapsford's or the minister's response, what I'd like to know is any further information about why Windsor suffered such a long delay in terms of being responded to. There was an issue in the community for quite a time before the report was written; a report was written and it took months before funding around it. Second, how much money has been allocated for this year? I can find about $40 million out of the $225 million talked about that is available. How much of that money, because we're already two or three months into the year, has already been allocated to hospitals, and what are the criteria? How do they get this money? How do they have access to it?
I'm specifically referring to the two funds that are in the report, approximately $35 million, I believe, for transitional beds so that when they're overrun in emergency they can open some and the ministry will pay for them, and second, for the short-term/long-term care beds, for which I understand there is a total allocation of $50 million.
I wonder if you could answer those three points for me.
Mr Sapsford: As far as the Windsor question is concerned, I think the minister covered what I was going to add. The primary recommendation of the report that was done specifically on Windsor was for the capital project to expand some of the physical space for the emergency department. As the minister said, that was approved some months ago.
The $35 million that's in the estimate for emergency services is related to a temporary opening of beds during the seasonal fluctuation. We have a working group with the Ontario Hospital Association looking right now at the allocation process for that $35 million. The $15-million allocation for temporary long-term-care beds as well is under discussion. We will shortly be putting questions out to hospitals as to which hospitals have capacity and are interested in providing those services. The anticipation is that that money would be allocated for the fall of this year, again for the seasonal fluctuation.
Mr Kennedy: Am I to understand then that none of the money has been spent so far?
Mr Sapsford: The only amount is the amount the minister just referred to.
Mr Kennedy: The specific amount that was declared at the original time for Windsor?
Mr Sapsford: That's correct.
Mr Kennedy: In terms of the future allocation then, there are organizations which have problems with their emergencies today, and the one thing I think the committee made very clear is that it's not just a seasonal problem. There are certain months, times of the year where it does become more amplified, but for example, in Toronto, we're looking at factors of twofold, threefold and fourfold increases in the unavailability of ambulances, which is one of the tables they produced in their report. Are you saying there's a committee that will work on it until the next high season of demand? There are organizations, hospitals out there that are having problems getting people into beds now. When will be the earliest they can access that money?
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Mr Sapsford: We're working on the allocation of the funding now. I think the other point, though, that the report raised was that some of the unavailability of hospital facilities was based on the fact that some hospitals were not complying with the guidelines around declaring oneself off-line, and so part of the report recommended that all hospitals involved in this process commit themselves to using the guidelines for booking off, as well as for some discharge criteria around patients in freeing up beds.
One of the other issues that was raised in the report was the lack of availability of intensive care unit beds, mostly because of the nursing issue, and part of the allocation as well will be to do some training for nurses to upgrade skills so that hospitals have a more adequate supply of critical care nurses. That program is moving forward, with discussion with the university to begin that training program as well.
Mr Kennedy: Let me just understand what you're saying, because there is a serious problem out there. Do you acknowledge that, Mr Sapsford?
Mr Sapsford: The report did, yes.
Mr Kennedy: Yes, the report did, and do you concur that there is a serious problem with emergencies?
Mr Sapsford: Yes.
Mr Kennedy: Because when you're talking about declaring off-line, I have a memo that you issued to the various emergencies asking them to follow a number of procedures, including cancelling elective surgery, a reminder that that is something they should do to keep the pressure off emergencies. When that memo went out or when those instructions went out from the ministry as a means of coping, did the ministry follow up and find out how many elective surgeries were cancelled to take the pressure off emergency rooms, how much of that behaviour? Is that something you then want to track and know what happened when you try and get those kinds of accommodations?
Mr Sapsford: We didn't specifically ask hospitals to report back on that. The point of the memo was that we were receiving information that hospitals were having problems in emergency departments and there was no change whatsoever in the utilization of hospital beds vis-à-vis elective surgery. In most cases where emergency departments become a problem, those patients presenting should receive priority, and the point of the memo was for hospitals to review their procedures around elective admission when the hospital was in fact booking off and not accepting critical patients.
Mr Kennedy: It strikes me that that's not terribly efficient, to be cancelling a number of times. There's a very human dimension there, because one of the people I had to assist was a woman named Ronda Durham, who's agreed to have her name used. She was at a Scarborough hospital, waiting for elective surgery, where she miscarried. She was sent away twice during this period of time and was told that surgeries were being cancelled, that postponements were being made.
I'm questioning, because I'd like you to have an opportunity to respond, whether your ministry -- and, ministry, I would be happy to have your response as well -- is sensitive enough in responding to emergency issues. Windsor took a long time to respond to. We have an emergency crisis that emerged in February. It took 10 weeks to get to a report, a report which recommended some funds which still haven't been disbursed. I'm just wondering, do you think it's a good strategy to cancel elective surgeries to make those kinds of adaptations on an ongoing basis? Because nothing structural will change, it doesn't sound like, in the next period here. Is that still a good strategy?
Hon Mrs Witmer: We need to remember that this is a long-standing problem. As I say, I can dig up headlines featuring Elinor Caplan dealing with the situation. It isn't a new situation. It's one that's been ongoing in this province for a number of years. That was clearly pointed out by people, as I say, who are neutral.
Also, I think I need to point out that the report did not assign any one reason as creating the problem, but what the report did say as well was that there were recommendations for the Ministry of Health and there were recommendations for the hospitals. It's really important that as we address issues in the health field we do so cooperatively with our partners. There is certainly a need for us to support the hospitals in order that they can address some of the issues they were asked to address by the task force, because, as has been mentioned, not all of them were following the guidelines. The guidelines should be followed. Obviously the primary concern always has to be in the hospitals and that's why they have the triage to deal with those who are the most ill, the most acute. We need to make sure that those people are dealt with first, and those decisions are made by people in the hospitals.
It's important to recognize that the report did indicate there was a responsibility for the Ministry of Health to take action, but also the hospitals.
Mr Kennedy: Minister, would you agree that the report did indicate that there were new stresses on the system, that some of these problems resulted from new factors, in fact new factors since your government was in office, that we have historical problems compounded by new factors? Do you recognize that that was part of the report?
Hon Mrs Witmer: The reality is that there are always going to be new factors that impact on any situation. As we move forward in life there are going to be new issues that arise that are going to create and compound problems. I'm pleased that we did take action. We said: "You know what? We have a problem and we're going to address the problem."
We did work cooperatively with the Ontario Hospital Association and, as Mr Sapsford has indicated, we are continuing to meet with them in order to ensure that as the money is allocated from the Ministry of Health, we can do so in areas where the money is most needed. We know that the hospitals are moving forward to respond to the recommendations, as they were given to the hospitals as well. So we're moving forward collaboratively to address problems, and at this point in time we need to do that and not assign blame. Let's move forward and make sure we can address the needs of patients in this province.
Mr Kennedy: What I'm looking for, Minister, if you'll pardon me for emphasizing, is accountability. There is only one place for accountability, and that is certainly beyond the hospital. It is the ministry. I think it's very clear that if there's going to be improvement, it's going to be driven by your recognition of the need for it.
Hon Mrs Witmer: I guess that's exactly why I did instruct the Ministry of Health staff to become involved in a task force with the Ontario Hospital Association. It was so that we didn't repeat this overcrowding one more time in another year. I'll read to you. This is Elinor Caplan; this was when a patient died during an ambulance transfer. In the Windsor Star of July 8, 1989, she said: "In these kinds of emergency situations it is common for physicians to use their medical judgement and determine that a patient should be transferred."
Again, in 1987, on the need for chronic care beds to alleviate the emergency room waits in Durham, Ms Caplan said, "The pressure for additional services and beds is not a phenomenon of just the past two years." We know that, and that's why we took action this year, because we want to make sure that we end and we deal with this situation. Certainly, Stephen Herbert, who was one of our co-chairs of the emergency room task force, has said that this was a difficult situation. He said, "It's not just a simple answer that comes from looking at the number of patients in the emergency room." He also indicated: "I don't believe that we have a crisis.... I can tell you that the situation in Toronto is not a crisis at this time." We wanted to make sure that we addressed this situation, and we have done so.
Mr Kennedy: Minister, I'd like to be more specific in what you consider acceptable and not acceptable. You obviously, in quoting that, don't believe there's any kind of crisis. Do you agree that people should not spend overnight in emergency room hallways? Is that a standard your government could subscribe to?
Hon Mrs Witmer: Our goal is to make sure that when people come into the emergency rooms they are treated as quickly as it can possibly happen.
Mr Kennedy: I'm specifically referring to the fact that they're triaged, they're found to be sick, they're diagnosed, they're waiting for a hospital bed and, instead of getting one, they go in the hallway. A woman of my acquaintance, 92 years old, spent eight days in Queensway hospital last year -- eight days in the hallway waiting for a bed. I'm specifically wondering whether that's a standard your government could subscribe to. Do you think the current program will eliminate that phenomenon of people getting care in hallways rather than in rooms, attended by nurses and getting good-quality treatment as a result?
Hon Mrs Witmer: That's why we set up the task force, because we want to make sure that any individual coming into any emergency room in this province is treated and provided with the type of service and accommodation as quickly as possible. That's why we have the interim long-term-care beds that are going to be set up. That's why we have invested additional dollars into community services in order that those people who are presently occupying acute care beds and preventing someone else from using those beds can be accommodated elsewhere. That's our whole objective: to make sure that people don't wait.
Mr Kennedy: I want to be clear, Minister. I do not doubt your overall objective. I am sure you're trying to do the best you can in the way you view the system. That's why it's so important for me to understand the specifics of what you're prepared to accomplish.
When will the money be available to the hospitals that are seeing the pressures today? Because the report was clear that this wasn't just a seasonal problem. I can give you lots of examples, if you like, of recent problems in emergency rooms. When will that money be available to start doing what you would like to achieve, and is it going to be enough? Is the program you have right now going to be enough to bring about the result that you and I would probably share and say we would want to have happen?
Hon Mrs Witmer: Obviously, we are moving forward now. If the situation does not improve and we see that there are still problems there, then obviously we have to continue, with our health partners, to take a look at the situation and make whatever additional changes are necessary, whether it is additional restructuring or investment of additional dollars. Then we need to continue to look at it. As Mr Strofolino, the CEO at the Hospital for Sick Children, said: "This is not a new problem.... We've certainly seen this over the last many years. I think that the issues that need to be addressed are not quick fixes, they in fact probably lie in further restructuring of the system."
So of course we need to move forward. As I say, we want to make sure that when people come, they're dealt with and they're accommodated if need be. If there continues to be a problem, we will continue to do whatever it takes to make sure people have the services they need as quickly as possible.
The Vice-Chair: Thanks very much, Minister and Mr Kennedy.
We will reconvene tomorrow with the third party. Have a good evening, everyone.
The committee adjourned at 1752.